Episode 47: What is A Rectus Diastasis?
What is a rectus diastasis? We'll start with a little anatomy. Your abdominal wall is composed of several layers. The outer most layer, which we're looking at all the time is the skin. Underneath that is some superficial or shallow fat. Underneath that is the abdominal wall itself, which consists of thick connective tissue called fascia and several muscle groups. And the most widely discussed of these are the rectus muscles or the rectus abdominis muscles. And these are paired muscles that run vertically up and down your abdomen and are responsible for the appearance of a six-pack. And they're also really central to core strength. And below this level, we get into the deep abdominal fat, which is also called the visceral abdominal fat, because it surrounds your viscera or internal organs, which are also sitting below the abdominal wall itself.
A rectus diastasis then, sometimes called a diastasis recti, is when the two paired rectus muscles, which remember are running vertically up and down your abdomen, become separated from one another. So there is only a weak layer of connective tissue that remains between these muscles and that separates the superficial fat above from your internal organs and visceral fat below.
What causes a rectus diastasis?
In our practice, the most frequent cause of rectus
diastasis, and we see this all the time, is pregnancy because during pregnancy the uterus grows and expands to accommodate the developing fetus. And as this happens, it often needs to make more room for itself than the rectus muscles are providing. So the growing uterus can essentially stretch out the abdominal wall and separate the rectus abdominis muscles from one another and this results in a rectus diastasis.
Is a rectus diastasis the same thing as a hernia? What happens to a rectus diastasis over time?
No, a rectus diastasis is not a hernia. The difference here is that a rectus diastasis is a separation of the rectus muscles, which leaves behind a weakened area of connective tissue between these muscles and the abdominal wall itself does remain intact, although it is weakened. In a hernia, and there are several kinds of hernia, but for the sake of this discussion were focusing on an abdominal hernia, there is actually a break or a hole in the abdominal wall, which can allow the deeper abdominal contents and visceral fat to bulge into or herniate into more superficial anatomical layers.
Can a rectus diastasis get worse over time? Yes. If you continue to place strain on your abdominal wall, either with further pregnancies or heavy lifting or anything else that can work to separate the rectus abdominis muscles from one another, the rectus diastasis can continue to evolve and worsen over time.
Is a rectus diastasis permanent? Unless steps are taken to address or fix a rectus diastasis it will remain permanently. These do not resolve or get better on their own.
Can a rectus diastasis be fixed?
Yes, it can. And we'll get into that in a little bit more detail in a moment.
Do you need to have surgery to fix a rectus diastasis? That's a bit more of a complicated question. And the reason is that there are some physical therapy maneuvers that can improve a rectus diastasis and help with core strength. And while in mild cases this therapy may significantly improve your core strength it will not actually fix the anatomical basis of the rectus diastasis.
Similarly, another non-surgical way to fix a rectus diastasis is with EMSCULPT. And this is a procedure we've discussed at length in other episodes, but essentially it uses highly focused electromagnetic energy or HIFEM to stimulate the abdominal muscles. In fact, it can generate up to 20,000 contractions in about 30 minutes. EMSCULPT can grow your rectus abdominal muscles, increase their muscle mass and in doing so it can actually reduce the width of a rectus diastasis by several percentage points.
However, again, I would not rely on EMSCULPT to treat a severe rectus diastasis, but in a mild case, it could offer some improvement. So unfortunately the only way to definitively manage a rectus diastasis is with surgery. And we do this in a tummy tuck or abdominoplasty, which we've also discussed in an earlier episode. But as far as it pertains to rectus diastasis during a tummy tuck or abdominoplasty, we actually identify the borders of the rectus abdominis muscles in the midline and then we actually sew those medial borders of the rectus diastasis muscles together in a process called plication.
So while a rectus diastasis is a very common problem and it can cause functional issues by making you feel like you have a weak core, or aesthetic issues by causing an abdominal bulge and making it very difficult to achieve a flat abdomen, rectus diastasis is fairly easily managed in minor cases by other physical therapy or with EMSCULPT and in a more severe cases with an abdominoplasty.